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Friday, March 24, 2017

Why Canadian Medicare is better than Obamacare or Trumpcare

What if a child with a potentially fatal disease had only one option for a cure, a treatment that costs 100 million dollars. Would you expect our publicly funded medicare system in Canada or a private insurance company in the USA to pay for it, or opt to let the child die under the theory that the 100 million dollars could be better spent saving many more lives?

It's a decision worthy of Sophie's Choice, where saving one life means condemning others to certain death, a decision that no rational human would feel comfortable making.
But the reality is that these decisions are made every day by government bureaucrats here in Canada or nameless insurance actuaries in the United States and belies the truth that we cannot provide maximum healthcare to all of our citizens, regardless of whether we are American or Canadian because we do not have the financial wherewithal to pay for it.

And so painful decisions have to be made, decisions that in effect ration healthcare on the basis of cost.
It is a healthcare pie that is to be divided, wherein Canada, each of us gets an equally small sliver or in the United States when the slices are decidedly uneven.
And there is the rub.
And so debate rages here and in the United States over which system can deliver the most for the least, despite the fact that no system can or will deliver all that is ideal and that, to all members of society.

The Canadian system is called single-payer, where the government provides all services related to healthcare and funds the system through special health levys and general taxes.
Both Obamacare and Trumpcare are hybrid systems where the government pay for about half the healthcare service, while the other half is funded by employers and administered by private insurance or health care providers using private doctors and healthcare facilities.

On the face of it, the Canadian system makes a lot more sense. It is plain and simple, eliminates the profit aspect and should in theory spread out health resources (hospitals and doctors) evenly, based on need instead of profit.
But like communist or social systems, it sounds a lot better on paper than in real life and the benefits as opposed to the free market system don't necessarily pan out.
Bureaucracy and low productivity are the Achilles heel of the single-payer system, whereby layers and layers of administrators rob the system of valuable resources and where inefficiency due to poor management and oversight, coupled with low productivity are the bane of the system.

This can be best illustrated by the administration of health services in Quebec versus the rest of Canada, whereby Quebec's infamous bureaucracy and abysmally low productivity rate demonstrate how two single-payer systems operating under the exact same rules can register different results.
Let us remember that 25% of Quebecers cannot find a family doctor despite the province paying for more doctors per capita than Ontario. It is illustrative of how bureaucracy, bad management and laziness makes Quebec's healthcare system so bad as compared to other Canadian provinces, despite having equal financial resources.

At any rate, healthcare in Canada is rationed through long waiting lists for surgery and treatments, and where appointments with doctors, especially specialists, takes much too long. Certain 'exotic' treatments and expensive drugs are just not available due to the perceived poor cost/benefit ratio and so many Canadians afflicted are deprived of essential treatments, condemned to suffer the consequences of non-treatment or forced to travel to the USA to get what they need or want, at their own expense. How many of us give up waiting in the emergency room because of the interminable hours upon hours of waiting? The societal cost of these delays is incalculable, but impactful just the same.

There is no doubt that long delays for appointments with doctors or waiting lists for surgery or treatment is not a problem in the United States, where health services are plentiful, superb and available almost on demand.
The problem here is getting in the door, where millions upon millions of Americans cannot avail themselves of these excellent services because they don't have the means to pay or the insurance to cover it.
This is the American version of rationing.

When people vaunt the benefits of the American system over the Canadian system they always point to the availability and quality of services as compared to Canada, but always fail to include the crucial aspect of access, whereby too many Americans are locked out of the medical system.

In the end no system is perfect, but let us consider that Canada spends half of what the USA does on healthcare and I can only imagine how much better our system would be versus Trumpcare or Obamacare if we had access to double our healthcare budget.

In the chart above you can see that the USA spends US$8,233 per person, per year on healthcare, while Canada spends almost half that at US$4,445, perhaps the key element in the USA/Canada debate on healthcare.

While most Americans have been frightened away from the concept of Canadian style single-payer system by the entrenched healthcare and insurance industry who constantly 'trump' up the negative aspects of our system, the reality is that only a fraction of Canadians would opt for Trumpcare or Obamacare care, despite the shortcomings of our system.

But before we get too full of ourselves, we shouldn't be too proud of our medicare system and ask ourselves the important question, how it is that countries like France, Great Britain, Germany and others, all have better healthcare systems than ours, while spending considerably less.

5 comments:

From my experience living in the UK, the systems are about equal. It is much easier to get a GP in the UK than it is in Canada (Quebec) but, at the hospital good look seeing a doctor unless you happen to be bleeding profusely from a stab wound in your neck. And even then, pray you're still alive after going through multiple levels of triage.

I have heard that of 11 OECD countries with socialized medicine, we were the 5th most expensive. We're not getting the best bang for our buck. Probably too many administrators. I know of one who got laid off, but she'll be getting 3 years pay as severance and she'll probably get her full RREGOP (public servant's pension plan) after that. Set for life at age 52! I too know of other Quebec civil servants who were able to retire in their 50s with full benefits. I know one who goes to Florida for 4 months over the winter and still has his benefits from when he was in the civil service. He got hit by a car there, and was fully covered for all his medical care, courtesy of the lavish benefits for Quebec civil servants. Same goes for most private sector jobs.

On the flip side, I read a few years ago about ex-Montreal doctors who went to the States for better opportunities, who now want to come back to semi-retire, and you'd think that would be a good idea considering Montreal is short of doctors, but Quebec said no. Oh, and of course, doctors have to speak reasonable French, too. If they fail their French tests, then what happens. Welcome to Ontario, and living here, I'm welcoming them with open arms.

Oh, and my buddy in Scotland's kids got their braces (teeth) for free, eye exams, medical forms filled out for free, etc. The Brits are doing it better and for less. Good for them, not for us, and if you work as a burger flipper in the U.S., G-d bless you!

"There is no doubt that long delays for appointments with doctors or waiting lists for surgery or treatment is not a problem in the United States, where health services are plentiful, superb and available almost on demand.The problem here is getting in the door, where millions upon millions of Americans cannot avail themselves of these excellent services because they don't have the means to pay or the insurance to cover it."

Yes they can...and do. In the U.S., you are either on a private healthcare program, not on a program, or are on Medicaid (a free program for the poor who pay ZERO premiums). Yes, those on a private healthcare program get the types of service you describe, Philip; but those without any program receive, by law, those services as well if they experience a catastrophic illness or accident. The law states that if you show up to an emergency room, the hospital must treat you. And if it is not an emergency and you have to be treated for, say, cancer most institutions and hospitals will provide you the service and will not turn you away...and will eat the cost. But they will, of course, try and get you on Medicaid first, so that the government pays.

The U.S. federal government's Medicaid bill is larger than the entire Canadian federal government's budget...and they only pay about half of Medicaid's cost because it is a shared federal/state program. So it isn't a small program but a significant portion of all medical costs incurred in the U.S.

The big problem in the U.S. and the main one that Obamacare attempted to address was for those without health insurance that did NOT qualify for Medicaid. If those people experienced a catastrophic medical situation, they were inevitably forced to "spend down" their assets for medical care until they DID qualify for Medicaid. And even then the law states that in order to qualify for Medicaid you still were allowed to keep one car, your home, your furniture, and a few thousand in cash. Not ideal, of course, but far from the picture you paint of "millions upon millions who cannot avail themselves of those excellent services...".

The medical services may not be on the same level as you services you describe for people with private medical insurance, Philip, but it is of a quality that I daresay is at least as good or better than anything that Canada has to offer.